September Is a Good Month to Talk About Memory

A little forgetting is normal. Knowing the difference is easier than it used to be, and you no longer have to leave Rockland to find out.

By Jeffrey Shenfeld, MD, Medical Director, The Brain Health Center, Suffern

There is an old joke that there are three signs of getting older. The first is memory loss. I forget the other two. It always gets a laugh, because everyone in the room has walked into the kitchen and stood there wondering why. I do it too, and memory is my line of work. A little forgetting comes with the years, like reading glasses and a knee that predicts rain.

But this is not a column about lost keys. Maybe you started a story at the Labor Day barbecue and saw the look on your daughter’s face, because you had told it an hour before. Maybe you drove to a store you have gone to for years and a familiar turn suddenly looked wrong. Or maybe it is your husband or wife you have been watching across the breakfast table, and you have not said anything yet.

Most people file these moments under getting older, and often they are right. Everyone forgets where they parked at the Palisades Center. What worries me is when someone forgets that they drove there, or when the reading glasses turn up in the refrigerator for the third time. The signs that matter are the ones that change how you live: trouble following a recipe you have made for forty years, unpaid bills on a counter that used to be tidy, or giving up bridge because keeping up has quietly become hard. New anxiety, or a low, withdrawn mood in someone who was never like that, can be the first sign too.

For years the honest advice was to watch and wait, because there was little to offer. That is no longer true. Two medicines, lecanemab and donanemab, are now approved by the FDA for early Alzheimer’s disease. They do not cure it, but they slow it down, which can mean more good years of driving, cooking, and living in your own home. The important word is early. These treatments are only for people in the first stage of the disease, and only after a scan or spinal fluid test has confirmed that amyloid, the protein behind Alzheimer’s, is present. Not everyone is a candidate, and we make that decision one patient at a time. Waiting a year to see how things go can mean waiting past the point where treatment is still an option.

There is a second, more hopeful reason not to wait. Many of the people who come to us worried about dementia turn out not to have it. A sluggish thyroid, low vitamin B12, sleep apnea, hearing loss, depression, or prescriptions that do not sit well together can all look like memory loss. Those problems can be treated, but only once someone has looked for them.

For Rockland residents, the looking has been the hard part. A full evaluation usually meant a referral into Manhattan or across the river, with separate appointments for the specialist, the scan, and the blood work, weeks or months of waiting in between, and someone to drive you each time.

I have watched people lose most of a year this way.

We opened our new Suffern office at 2 Executive Boulevard to change that. Under one roof we do the memory and thinking tests, blood work that now includes a test for a protein tied to Alzheimer’s, brain wave recording, ultrasound of the arteries that supply the brain, and testing of the nerves that control blood pressure and heart rate. Because dizziness and falls are such a common worry, we test balance and the inner ear as well. PET and MRI scans, when needed, are arranged nearby. The workup is usually finished within a few weeks, and a written report goes to your own doctor.

For patients who qualify for the new Alzheimer’s medicines, we give the infusions right here in our office. We are the only private practice in Rockland County that does, so there is no long drive to a separate infusion center on treatment days. For mood and memory together, we also offer transcranial magnetic stimulation, which is FDA-cleared for depression, and photobiomodulation, a newer light-based therapy still being studied, as part of a drug-free, holistic approach.

If you have been putting this off, I understand. Nobody is eager to hear the answer, and nobody wants to be talked about as if they were not in the room. But a memory checkup is no different from a cholesterol check or a colonoscopy. You do it because you want to keep living the way you live now, and you do not need anyone’s permission to make the call. If it is your spouse you are worried about, do not open with the incident. Nobody wins that argument. Suggest a checkup for both of you, and go together.

September is World Alzheimer’s Month, and like every September it will be gone before you know it. Before it is, make the appointment. The answer may well be reassuring. If it is not, you will have found out while the most can still be done.

The Brain Health Center Neurology, Psychiatry, Cognitive Health Suffern, NY: 2 Executive Blvd., Suite 103, (845) 889-5088  Englewood, NJ: 401-A S. Van Brunt Street, Suite 302, (201) 947-4777

Medicare, Fidelis, and major insurance plans accepted. TheBrainHealthCenter.com